Risk of Acute Vascular Complications in Patients with Calcinosis of Aortic Valve and Ischemic Heart Disease

The aortic valve calcinosis in patients with ischemic heart disease is associated with an increased risk of sudden death. This fact requires searching informative prognostic criteria course of ischemic heart disease.
The purpose of our study was to examine clinical data, coagulation hemostasis, and the risk of acute complications in patients with aortic valve calcification and ischemic heart disease.
Material and methods. This study involved 116 male patients aged 36-78 (median 59 years) diagnosed with ischemic heart disease (stable angina, prior myocardial infarction, after coronary bypass surgery and stenting). The diagnosis of ischemic heart disease was based on clinical examinations, electrocardiography, echocardiography (left ventricular ejection fraction, heart chambers in diastole, left ventricular hypertrophy, mild (isolated small spots) and moderate (multiple bigger spots) calcification of the aortic valve, bicycle ergometry, coronarography and laboratory investigations (total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, fibrinogen, soluble fibrin-monomers, D-dimer).
Statistical analyses were performed using Statistica for Windows 5.0 program. Data are presented as the median [lower-upper quartiles]; comparisons between groups were made using the Mann-Whitney U-test. Categorical data were assessed using the Fisher exact test, the correlation between variables was studied by Kendall's correlation test, survival curves during 36 months was studied by the Kaplan-Meier method with significant difference between the groups – by Cox's F-test.
Results and discussion. We divided patients into two groups: group 1 comprised 60 (52 %) patients with ischemic heart disease without calcinosis of aortic valve and group 2 consisted of 56 (48 %) patients with calcinosis of aortic valve. Patients of group 2 compared to group 1 had higher median value of fibrin-monomers (median 4.3 and 3.5 mg/dL, р=0.003); triglycerides (median 180 and 133 mg/dL, р=0.048); body mass index (median 27 and 25 kg/m², р=0.008). The increased level of fibrin-monomers (≥4 mg/dL) occurred in 66 % patients of group 2 and in 40 % patients of group 1 (p=0.005). According to results of correlation analysis, a significant correlation was found between fibrin-monomers and fibrinogen (τ=0,175, р=0.004), D-dimer (τ=0,315, р=0.04).
To assess the course of ischemic heart disease in patients we took those who had been under observation for 3 years after clinical examination. The final point of observation was the registration of acute vascular complications: acute coronary syndrome, stroke, peripheral thrombosis. Retrospective analysis of prognostic value showed that the cumulative proportion of survival during 36 months in patients with calcinosis of aortic valve was 68 %, whereas in patients without calcinosis of aortic valve it was 83 % (Cox's F-test, p=0.048).
Conclusion. The aortic valve calcinosis in patients with ischemic heart disease is associated with obesity, higher soluble fibrin-monomers level, which confirms the activation of blood coagulation, thrombus formation and is an unfavorable prognostic factor for the development of acute vascular complications during two and three years of observation.